Page 17 - World Journal of Laparoscopic Surgeons

WJOLS

Utpal De, Pronoy Kabiraj 10.5005/jp-journals-10007-1326
ORIGINAL ARTICLE

Preoperative Infraumbilical Anthropometry: A Selective

Guide to Endoscopic Hernia Repair—A Pilot Study

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1 Utpal De, Pronoy Kabiraj

ABSTRACT Table 1: Indications for TAPP and TEP 1
Introduction: Specific preoperative indications for endoscopic TEP TAPP
hernia repair are nonexistent. The study was aimed to examine Primary hernia: Unilateral or Incarceration or strangulation
the feasibility of preoperative infraumbilical anthropometry (PIA) bilateral
as a guide to define endoscopic repair. Recurrent hernia following Scrotal hernias
open hernia repair
Materials and methods: Forty-five patients were recruited for
the study based on predefined inclusion and exclusion criteria. Prior abdominal surgical Inguinodynia
history—even involving midline
Preoperative anthropometric measurements (fixed bony points
of pelvis and umbilicus) were done. All patients were subjected Open prostatectomy Recurrence after TAPP or TEP
to total extraperitoneal repair (TEP). Failure of TEP was con- Patients with previous
verted to transabdominal preperitoneal repair (TAPP) and Pfannenstiel incision
reasons for conversion were noted and statistically analyzed.
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Results: A total of 33 patients underwent TEP (73.3%) and 12 TEP as the available working space is more. But TEP has
(26.7%) patients had to be converted to TAPP. Raised body the advantages of less postoperative pain, early ambu-
mass index (BMI) [mean 22.53, standard deviation (SD) 0.35, lation, and lower recurrence rate. Lack of peritoneal
2-4
p < 0.001], increased infraumbilical fat pad thickness (mean
2.77 cm, SD 0.27, p < 0.00), and pelvic anthropometric param- breach and nonfixation of mesh has led to cost-effective
eters were found to be significant (p < 0.001). outcome. Though several factors have been postulated
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Conclusion: Preoperative pelvic anthropometry could be a as contraindications for TEP and indications for TAPP,
selective guide to endoscopic hernia repair. none of the reports have taken into consideration PIA as
Keywords: Anthropometry, Endoscopy, Hernia, Treatment. a guide to endoscopic hernia repair.
Our study was aimed to explore this gray area to
How to cite this article: De U, Kabiraj P. Preoperative Infra-
umbilical Anthropometry: A Selective Guide to Endoscopic deduce if PIA could guide endoscopic herniologist to
Hernia Repair—A Pilot Study. World J Lap Surg 2018;11(1):8-11. choose specific (TEP/TAPP) surgery for defined patients
Source of support: Nil with inguinal hernia.
Conflict of interest: None
MATERIAlS AND METHODS
The study was performed in the Department of Surgery
INTRODUCTION
from March 2014 to February 2015. Forty-five patients
A quarter of a century has passed since minimally inva- with inguinal hernia were included in the study. All
sive hernia surgery assumed a place in the pantheon of the patients were admitted through the outpatient
hernia repair. Since then, numerous studies have been department. After proper history taking and thorough
published focusing primarily on intraoperative con- clinical examination, patients were recruited based on
1
strains and postoperative outcome. During the same time specific inclusion and exclusion criteria. Inclusion crite-
frame, certain individualistic indications do seem to cry ria included patients of any sex, age more than 18 years,
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out for a hernia-specific endoscopic approach (Table 1). primary, unilateral, uncomplicated, incomplete, reduc-
Specific preoperative patient selection criteria for a ible, direct or indirect, inguinal hernias.
particular endoscopic technique is yet to be evolved. Exclusion criteria included patients with bilateral
Transabdominal preperitoneal is considered superior to hernia, previous lower abdominal surgery (open prosta-
tectomy, lower segment cesarean section, appendectomy
scar, and midline laparotomy scar), soft tissue tumors in
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1 Professor, Postgraduate Trainee the inguinal region on abdominal sonography, patients
1,2 Department of General Surgery, Bankura Sammilani Medical with concomitant varicocele, undescended testes, ingui-
College, Bankura, West Bengal, India nal lymphadenopathy, general contraindications for

Corresponding Author: Utpal De, Professor, Department of laparoscopic surgery, and unwilling patients.
General Surgery, Bankura Sammilani Medical College, Bankura History taking included duration, straining factors
West Bengal, India, e-mail: utpalde@vsnl.net
(chronic cough, lower urinary tract symptoms, and
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